Looking for opinions--Outer boot- replies
Kevin Matthews
Description
Collection
Title:
Looking for opinions--Outer boot- replies
Creator:
Kevin Matthews
Date:
7/29/2007
Text:
Hello all. A couple weeks ago I posted the following query to the list. The original post along with replies are attached. I wasn't able to get the child to neutral because I didn't take the time to loosen him up. I trust his therapist and he said he'll get there. I have photos of the finished product if anyone is interested. The replies run the gambit. From I'm a fool to interesting design and thought. I don't mind criticism at all, I'm comfortable with my thought processes. I do like the finished product and will use it as another tool in the box.
I'll break this down into two replies with only the first containing my original post. Thanks to those few who replied.
ORIGINAL POST
My name is Kevin Matthews. I'm an orthotist in San Antonio (Go Spurs). I had an idea for an AFO design for a child with significant tone. This particular child has decent range on the right, but I couldn't get the left to range to neutral. His therapist said he can get him to neutral. This child has an appointment for evaluation for Botox in both LE's next month. Typically I would recommend an inner boot on the left for a child with this amount of tone, or contracture of the joint. I'm not a big fan of one piece wraparound AFO's.
Now, the reason for my call. In considering design for this child a thought occurred to me. A little about me. I'm one of those who are constantly trying to reinvent the wheel. You'd think after 25 years I'd have my designs down. Well, I don't. Since this child will probably be getting Botox in a month or so, he may not need the inner boot. If possible I'd rather avoid putting him in an inner boot that becomes unnecessary.
So this is my idea. How about an outer boot. I think this may work and I'd like to know if any of you have tried this and if it was successful. The benefits of an outer boot is that it can be DC'd if child gains range. I am going to make it from 3/32 copoly over a 1/8 polypro solid AFO. I will cut windows in copoly to make it easier to don as most of the plastic will be unnecessary if you think about it. It will also allow use of just the AFO sometimes and when more support/control is needed you can add outer boot.
If you need more info just ask. I'll take pictures of the orthosis as I make it. It might have been better to wait until after I fit it, but I'd like thoughtful discourse on this design which I'll post to the list when compiled. I'm sure this has been tried before and helpful input may help me to avoid complications due to something I may have missed.
I will post responses with credentials unless asked not to. I feel it will be beneficial to know who advice is coming from. If possible include your years of experience in your reply. So, what do you think of my idea and do you feel it will work? I'm more interested in your thoughts on design and variations you may have tried, not the treatment protocol.
Responses
For your patient with left lower leg contractures and high tone:
I wonder if the search for a temporary solution is the best option.
The fact that your patient will have Botox soon does not mean that a
proper, longer lasting orthosis with improved function and cosmesis
cannot be recommended. The orthosis is definitely needed after the Botox has
been administered. The Botox will be a great help to reach the goals in correcting the
ankle and foot structures. The majority of our patients with high tone and contractures will have night-splints ánd functional, dynamic orthosis during day time when
they are active.
It is my opinion that an outer booth is not ideal for correcting the
delicate structures of foot and ankle.
Wishing You Success with your research !
Kind Regards,
Jan Smits, C.P.O. (40 yrs of experience in orthotics)
Research & Product Development
Camp Scandinavia AB
Sweden
Hello Kevin,
My name is Henry Jones CO and have been in the same
situation several times in my 25 plus years in the
field. I have found that most children grow out of the
benifits of the botox intervention and require
multiple braces due to the see-saw effect.
Compliance,out of your realm of control seems to be
a big factor and I have simply made multiple braces
for these ever changing pathology patients. The end
result has cost me 10 dollars in plastic and 20
dollars in time, however saved countless hours
adjusting and recasting the not so easy to cast
patient. Parents have told me yeah, my child wears
the brace all the time yet we all can look at a
orthosis and tell in a instant if they are telling the
truth. To cut your time and effort, I would simply
make 2 braces and eat the cost. One for now with the
inner boot, and one for later from the same cast mold.
You seem to have the childs best interest in mind and
that is commendable, but time is money.
H.R.Jones CO
Kevin,
Your design is not that different than some of the TC2 designs from
Orthomerica or Cascade. As far as what it will look like, it will be
set for
the individual so it will match your patient's needs.You might also
check
and see if you want to use a internal decreasing wedge between the
outer and
inner boot so that the orthosis allows the child to stretch out to
neutral a
little bit at a time.I've done it with an extrinsic heel post that is
inset
into the plastic of the outer boot in 1/8 wedges depending on the
plantar
flexion of the ankle. By the way reinventing the wheel can be fun.
Good Luck,
Carey Glass CPO FAAOP
Cool idea. I don't read many posts that actually think outside the box
and it is refreshing to see a colleague go out on a limb with a novel
idea for others to see. You might try modified polyethe instead of
copoly but 3/32 copoly should be flexible enough.
Buck Toenges C.P.O.
I'm not sure I understand what the benefit would be of an outer co-poly
boot over and inner poly solid AFO. I do loads of pediatrics. What is the Dx
of the patient?
If the patient has some range, and of course the PT claims she can get
to neutral, than why not an articulating AFO with an adjustable stop?
Cast at best range now, and improve the range as Botox works.
Sounds simple enough. I must be missing something.
Good luck,
Andrew A. Cinque CPO
JK Prosthetics & Orthotics Inc.
Cell: (914) 755 5145
Office: (914) 699 2077
Kevin C. Matthews, CO/LO
Certified/Licensed Orthotist
Advanced Orthopedic Designs
12315 Judson Rd. Suite 206
San Antonio, TX 78233
Phone: 210-657-8100
Fax: 210-657-8105
I'll break this down into two replies with only the first containing my original post. Thanks to those few who replied.
ORIGINAL POST
My name is Kevin Matthews. I'm an orthotist in San Antonio (Go Spurs). I had an idea for an AFO design for a child with significant tone. This particular child has decent range on the right, but I couldn't get the left to range to neutral. His therapist said he can get him to neutral. This child has an appointment for evaluation for Botox in both LE's next month. Typically I would recommend an inner boot on the left for a child with this amount of tone, or contracture of the joint. I'm not a big fan of one piece wraparound AFO's.
Now, the reason for my call. In considering design for this child a thought occurred to me. A little about me. I'm one of those who are constantly trying to reinvent the wheel. You'd think after 25 years I'd have my designs down. Well, I don't. Since this child will probably be getting Botox in a month or so, he may not need the inner boot. If possible I'd rather avoid putting him in an inner boot that becomes unnecessary.
So this is my idea. How about an outer boot. I think this may work and I'd like to know if any of you have tried this and if it was successful. The benefits of an outer boot is that it can be DC'd if child gains range. I am going to make it from 3/32 copoly over a 1/8 polypro solid AFO. I will cut windows in copoly to make it easier to don as most of the plastic will be unnecessary if you think about it. It will also allow use of just the AFO sometimes and when more support/control is needed you can add outer boot.
If you need more info just ask. I'll take pictures of the orthosis as I make it. It might have been better to wait until after I fit it, but I'd like thoughtful discourse on this design which I'll post to the list when compiled. I'm sure this has been tried before and helpful input may help me to avoid complications due to something I may have missed.
I will post responses with credentials unless asked not to. I feel it will be beneficial to know who advice is coming from. If possible include your years of experience in your reply. So, what do you think of my idea and do you feel it will work? I'm more interested in your thoughts on design and variations you may have tried, not the treatment protocol.
Responses
For your patient with left lower leg contractures and high tone:
I wonder if the search for a temporary solution is the best option.
The fact that your patient will have Botox soon does not mean that a
proper, longer lasting orthosis with improved function and cosmesis
cannot be recommended. The orthosis is definitely needed after the Botox has
been administered. The Botox will be a great help to reach the goals in correcting the
ankle and foot structures. The majority of our patients with high tone and contractures will have night-splints ánd functional, dynamic orthosis during day time when
they are active.
It is my opinion that an outer booth is not ideal for correcting the
delicate structures of foot and ankle.
Wishing You Success with your research !
Kind Regards,
Jan Smits, C.P.O. (40 yrs of experience in orthotics)
Research & Product Development
Camp Scandinavia AB
Sweden
Hello Kevin,
My name is Henry Jones CO and have been in the same
situation several times in my 25 plus years in the
field. I have found that most children grow out of the
benifits of the botox intervention and require
multiple braces due to the see-saw effect.
Compliance,out of your realm of control seems to be
a big factor and I have simply made multiple braces
for these ever changing pathology patients. The end
result has cost me 10 dollars in plastic and 20
dollars in time, however saved countless hours
adjusting and recasting the not so easy to cast
patient. Parents have told me yeah, my child wears
the brace all the time yet we all can look at a
orthosis and tell in a instant if they are telling the
truth. To cut your time and effort, I would simply
make 2 braces and eat the cost. One for now with the
inner boot, and one for later from the same cast mold.
You seem to have the childs best interest in mind and
that is commendable, but time is money.
H.R.Jones CO
Kevin,
Your design is not that different than some of the TC2 designs from
Orthomerica or Cascade. As far as what it will look like, it will be
set for
the individual so it will match your patient's needs.You might also
check
and see if you want to use a internal decreasing wedge between the
outer and
inner boot so that the orthosis allows the child to stretch out to
neutral a
little bit at a time.I've done it with an extrinsic heel post that is
inset
into the plastic of the outer boot in 1/8 wedges depending on the
plantar
flexion of the ankle. By the way reinventing the wheel can be fun.
Good Luck,
Carey Glass CPO FAAOP
Cool idea. I don't read many posts that actually think outside the box
and it is refreshing to see a colleague go out on a limb with a novel
idea for others to see. You might try modified polyethe instead of
copoly but 3/32 copoly should be flexible enough.
Buck Toenges C.P.O.
I'm not sure I understand what the benefit would be of an outer co-poly
boot over and inner poly solid AFO. I do loads of pediatrics. What is the Dx
of the patient?
If the patient has some range, and of course the PT claims she can get
to neutral, than why not an articulating AFO with an adjustable stop?
Cast at best range now, and improve the range as Botox works.
Sounds simple enough. I must be missing something.
Good luck,
Andrew A. Cinque CPO
JK Prosthetics & Orthotics Inc.
Cell: (914) 755 5145
Office: (914) 699 2077
Kevin C. Matthews, CO/LO
Certified/Licensed Orthotist
Advanced Orthopedic Designs
12315 Judson Rd. Suite 206
San Antonio, TX 78233
Phone: 210-657-8100
Fax: 210-657-8105
Citation
Kevin Matthews, “Looking for opinions--Outer boot- replies,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/228415.
